Based on the original Electronic Arts first person shooter "Medal of Honor : Allied Assault", this expansion pack game is a must have for all historical WW2 era battle simulator enthusiasts. The protagonist is U.S Army sergeant John Baker, and it follows the real life Allied thrust into Southern Europe from Kasserine Pass in North Africa and the Mediterranean island of Sicily to mainland Italy itself to do battle with the Wehrmacht in Monte Battaglia in central Italy.

Developers TKO software promised (before its release back in 2003)that the expansion pack would feature a suite of new weapons, vehicles and objectives. The "breakthrough" expansion pack does not add any weapons of note, although it is constrained by a desire to simulate a historical battle, so the weapon style and schematics are relatively limited compared to fictional first person shooter franchises.

Like the main "Medal of Honor" games,the "Breakthrough" expansion pack requires speed of response and accuracy as Sgt Baker battles an ever multiplying swarm of German troops. The scripted cinematic sequences still stand the test of time regarding quality, but the game play itself feels very ordinary compared to the likes of "Call of Duty". Parts of the game are too easy, for example when Sgt Baker is mounted on a tank or armored jeep, mowing down Nazis with a machine gun from safe difference. This low level of challenge makes the game play pass almost too quickly. The AI of the game is very poor, even when judged by the standards of its time. German and Fascist Italian troops ignore Sgt Baker, even when he is standing a mere meter away!

Graphically, Medal of Honor: Breakthrough looks almost identical to Medal of Honor: Allied Assault. It includes excellent features such as life like shadows and fog, solid particle effects, realistic-looking weather effects (namely rain, fog, snow, and even desert storms), superbly animated in-game character models, and so on. But disappointingly, most of the aforementioned effects cannot be enjoyed unless the player has pushed the game to its maximum performance, which is very time consuming and means having to stick through the easy and often boringly repetitive game play.